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Thalassemia and dentistry

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In the Name of God

Thalassemia and dentistry by : Abdolreza maadi DDS

May 2011-Antalia

Charity foundation for special Diseases

The existence of such necessities in one hand , and the need to have access to the health and therapeutic efficiencies on the other hand ,resulted to the establishment of a voluntary and popular organization named Charity Foundation for Special Diseases (CFSD) ,BY Mrs .Fatemeh Hashemi Rafsanjani, the then president of the I.R. of Iran ,some national benevolent individuals ,and health and therapeutic authorities within the framework of a non-govermental organization (Charity),to help for promotion of therapeutic and quality of life of patients with

Tasks (Programmes):

To prepare and to implement educational courses on special diseases for interested volunteers and the patients.

Preparation of cultural ,educational ,health ,therapeutic and economic projects for special diseases.

Providing consultation to the patients for their treatment, and participation in the establishment of medical centers for special

diseases

Thalassemia and dentistry

Since 1386 and while investigating the medical protocol of patients with Thalassemia and drawing up a timetable for 150 patients at the Special Diseases Center regarding the periodical visits of cardio, glands, hearing ability, bone density,... as well as need assessment and evaluation of patients we realized two important issues. The emotional and consultation needs of patients, their dental problems and concern for oral health are three main concerns. The face and mouth are the first areas of a person-healthy or unhealthy- which are exposed to the surrounding environment and this in many cases can manifest signs of disease and lead to a communication between the dentists and the patient.

To this end and to get to a novel concept, dental treatments for patients with thalassemia were taken into account and the scene was set for holding an academic seminar on the topic in 1386, 1387 and 1389. What follows is a summary of the issues raised by Iranian professors and researchers in the field:

Given that oral and dental health is part of general health, paying attention to dental treatments for individuals of all ages and socioeconomic status and even those diagnosed by a disease.

Those suffering from Thalassaemia, though, need further attention to their dental and oral health given their constant use of medicine, low tolerance threshold, inattention to oral and dental health, emotional stress and heavy costs of treatment. Taking oral and dental health into consideration in treatment protocols and establishing links between the medical and dental sections as well raising awareness among patients with regard to oral and dental health play important roles in getting to the desirable conditions. Knowing this, it is necessary to incorporate treatment management of such patients in the dental setting into the curriculum of dentistry students and those in the continued education. In the meantime, attention to dental care for these patients at a younger age, hygiene education for the patient and his/her family, change in diet and encouraging the patient to go through three-month medical exams and 6-month dental exams are some vital elements aiding the doctors in getting to the above mentioned goals.

Dental considerations regarding patients with special diseases,seminars,performed in Special diseases' foundation:

1-2007seminar with 100 dental doctors participants.

2-2008seminar with 200 dental doctors participants.

3-2010seminar with 400 dental doctors participants.

The goal of the seminars and the target groups:

1-The people in charge of health planning system

2-Medical and dental doctors

3-Patients and their families

4-Scientists and survayors

*Television and press newsletter programmes

*Publishing books related to the topics presented

*Educational and informing interviews

*Preparing brochures and educational pamflets for patients with special disease

*Informing through posters and banners

Radiographic Characteristics of beta major thalassemia

The changes in beta major thalassemia patients bones that are caused by bone marrow hyperplasia can be observed in the radiographic images diploe in the cranial bones experience expansion that the inter plate space becomes widened while the external and internal part of the plate becomes thinner . The frontal bone creates a vertical tubercle that is parallel with the diploe plate external plate and ,due to erythroid hyperplasia ,the parietal bone has a porous part in the diploe plate external part that creates hair on end or sun ray appearance appearance 3,20-8 the tubercle on the jaw bone can be seen in the panoramic image and gives honeycomb appearance

Oral cavity characteristics of beta major thalassemia patients

The oral cavity of the beta major thalassemia patients shows the following characteristics the upper jaw seems to be bigger due to the bone marrow expansion

The facial feature is known as chipmunk facies . The lower jaw is wider than a normal lower jaw . the tooth size is similar to normal child tooth except for the multiple diastema due to faster jaw growth . the periodontal ligament will seem widened as a result from class II division 1 malocclusion . The gingival is pale especially when the patients Hb drops to below 8gr/dl .The color of the gingival sometimes tends to be dark , which is caused by the high ferritin level in the blood .The tongue size is bigger/macroglossi as a result from bigger arches.

Considerations during dental treatment

The treatment for beta major thalassemia is performed routinely especially when patients experience decreasing hemoglobin level .Therefore ,the dental treatment should be performed by paying attention to these following considerations. consult all dental treatments planned with the hematologist . The dental treatment should be performed in a short time as possible and should be done after the patient receives blood transfusion .Do not dental treatment when the hemoglobin level is less than 100gl/l provide antibiotics prophylaxis especially for children who have undergone splenectomy if an orthodontic treatment is needed , the dental movement should be wached closely because there may be faster movement compared to the normal situation the retention phase is also more difficult in these patients

Dental consideration

Dentistry treatment in the 1st and 2nd week after injection.

Haemoglobin level control

Short treatment time to avoid tiredness

Health suggestions:

1-periodical examination every 3 months.

2-Tutoring teeth brushing

3-Floridentherapy

4-Fisure scalant

5-nutrition consultation

Recommended treatment:

1-Health education and regular checkups

2-Timely orthodontistic treatments

3-Cheek or jaw surgery if necessary

Recommendations:

The necessity of paying attention to oral-dentalnhealth in Thalassemic patients protocol

Promoting the insurance support in dentistry treatment of such patients

Building and enhancing Dentistry centers specialized for this sort of patients

Presenting workshops for patients,their families,nurses and medical doctors

Producing brochures,pamphlets and educative movies

Recommending change in eating diet and tempting the patient to have regular examinations.